Szathmári M, Tulassay T, Arató A, Bodánszky H, Szabó A, Tulassay Z
1st Department of Medicine, Semmelweis University Medical School, Korányi Sándor utca 2/A, Budapest, Hungary.
Eur J Gastroenterol Hepatol. 2001 Apr;13(4):419-24. doi: 10.1097/00042737-200104000-00020.
Osteoporosis is a complication of coeliac disease. A gluten-free diet improves but does not normalize bone mineral density in adult patients. Only limited data are available regarding the influence of the disease and diet on bone mineralization in children. The aim of this study was to evaluate the radial bone mineral content and density in children and adolescents who are asymptomatic on a gluten-free diet.
The bone mineral content (BMC) and density (BMD) values of the non-dominant radius midshaft in 91 children (53 girls, 38 boys, mean age 11.7 years, mean duration of disease 8.7 years) were determined by single-photon absorptiometry. At the diagnosis and at least three years after commencement of a gluten-free diet, serum calcium, phosphorus, albumin concentrations and alkaline phosphatase activities were measured in all patients, and intact parathormone concentrations in 16 patients.
The mean BMC Z-score value in the female adolescent group only was significantly lower than normal (mean Z-score -1.04, P < 0.01). In contrast, the mean BMD Z-score was significantly higher compared to a healthy population both in girls (mean Z-score +1.36, P < 0.001) and in boys (mean Z-score +0.53, P < 0.02), as well as in the total patient group (mean Z-score +1.01, P < 0.001). The radial diameter was significantly smaller than normal in both pre-pubertal and adolescent groups. Serum laboratory parameters of asymptomatic patients were in the normal range. The parathormone mean value was significantly lower after at least three years of gluten-free diet than at diagnosis (mean +/- SD 3.77 +/- 1.07 versus 7.89 +/- 2.54 pmol/l, P < 0.01), but significantly higher compared to controls (2.89 +/- 0.90 pmol/l, P < 0.05).
These data indicate that treated, asymptomatic coeliac children and adolescents have normal or even higher radius mineral density values than controls, but the bone size remains reduced. Although there is no direct evidence of calcium malabsorption in this cohort of coeliac patients, the slightly higher parathormone levels, together with some other factors, particularly delayed puberty, may result in reduced bone size.
骨质疏松是乳糜泻的一种并发症。无麸质饮食可改善成年患者的骨矿物质密度，但不能使其恢复正常。关于该疾病及饮食对儿童骨矿化的影响，仅有有限的数据。本研究的目的是评估采用无麸质饮食且无症状的儿童和青少年的桡骨骨矿物质含量及密度。
采用单光子吸收法测定了91名儿童（53名女孩，38名男孩，平均年龄11.7岁，平均病程8.7年）非优势侧桡骨中轴的骨矿物质含量（BMC）和密度（BMD）值。在诊断时以及开始无麸质饮食至少三年后，测定了所有患者的血清钙、磷、白蛋白浓度及碱性磷酸酶活性，16名患者还测定了完整甲状旁腺激素浓度。
仅女性青少年组的平均BMC Z评分值显著低于正常水平（平均Z评分-1.04，P<0.01）。相比之下，女孩（平均Z评分+1.36，P<0.001）、男孩（平均Z评分+0.53，P<0.02）以及整个患者组（平均Z评分+1.01，P<0.001）的平均BMD Z评分均显著高于健康人群。青春期前组和青少年组的桡骨直径均显著小于正常水平。无症状患者的血清实验室参数均在正常范围内。无麸质饮食至少三年后的甲状旁腺激素平均值显著低于诊断时（平均±标准差 3.77±1.07对7.89±2.54 pmol/L，P<0.01），但显著高于对照组（2.89±0.90 pmol/L，P<0.05）。
这些数据表明，接受治疗且无症状的乳糜泻儿童和青少年的桡骨矿物质密度值正常甚至高于对照组，但骨骼尺寸仍然减小。尽管在这组乳糜泻患者中没有钙吸收不良的直接证据，但甲状旁腺激素水平略高，以及其他一些因素，尤其是青春期延迟，可能导致骨骼尺寸减小。
